Blood pressure fluctuates naturally throughout the day and tends to increase around the time a person wakes up. However, for many people, blood pressure may be abnormally high in the mornings. Doctors refer to this as morning hypertension.
Morning hypertension can increase the risk of heart attack and stroke. These medical emergencies often occur in the early hours when blood pressure rises.
In this article, we explore the causes and effects of morning hypertension. We also look at ways in which people can prevent and control this condition.
Normal blood pressure pattern
Stress or anxiety may influence blood pressure in the morning.
Blood pressure refers to the force with which the heart pumps blood around the circulatory system. Several factors can influence blood pressure, including:
- stress or anxiety
- physical activity
- diet
When a person measures their blood pressure, the reading will appear as two numbers. The top number denotes systolic blood pressure, which is the pressure when the heart contracts. The bottom number shows diastolic blood pressure, which is a measure of the pressure when the heart relaxes.
A blood pressure monitor uses a unit of measurement called millimeters of mercury (mm Hg) to measure the pressure inside the blood vessels. Normal blood pressure is less than 120/80 mm Hg.
Readings between 120/80 mm Hg and 139/89 mm Hg indicate that a person is at risk of developing hypertension, while readings of more than 140/90 mm Hg signify hypertension.
Blood pressure rises and falls throughout the day and night. During sleep, blood pressure falls by 10–30%. It then increases around the time of wakening. In some people, this increase may be significant, resulting in morning hypertension.
Causes
Some potential causes of morning hypertension include those below.
Medication
Some people take antihypertensive medications to control their blood pressure. According to review, uncontrolled morning hypertension may indicate a problem with the type or dosage of these medications.
Specifically, morning hypertension may be due to one or more of the following factors:
- taking a medication dosage that is too low
- taking short-acting or intermediate-acting medications rather than long-acting medications
- taking a single antihypertensive medication rather than a combination of medications
Some people may find that taking their medications before bed rather than in the morning provides better blood pressure control. Others may need to split their daily dose, taking half in the morning and half before bed. In some cases, a person may need to change to another type of blood pressure drug altogether.
It is important to speak to a doctor before making any changes to medications.
Medical conditions
Certain medical conditions may increase the risk of hypertension. These include:
- untreated high blood pressure
- high cholesterol
- cardiovascular disease
- obstructive sleep apnea
- diabetes
- thyroid disorders
- Cushing’s syndrome
- Lupus
- Scleroderma
- kidney disease
Lifestyle factors
Certain lifestyle factors can also increase the risk of hypertension. Examples include:
- smoking
- heavy alcohol consumption
- eating a diet high in salt and saturated fat
- not getting enough exercise
Who is at risk?
The following factors can increase a person’s risk of developing morning hypertension:
- being over the age of 65 years
- being of African or Caribbean descent
- having a relative with high blood pressure
- having overweight or obesity
- drinking alcohol
- smoking
- anxiety or excessive stress
- insufficient sleep
- disturbed sleep, for example, working night shifts
When and how to measure blood pressure
Regular use of a home blood pressure monitor can help people better understand their blood pressure fluctuations. It can also allow people to identify episodes of morning hypertension.
Before measuring blood pressure:
- Empty the bladder.
- Rest comfortably and quietly for 5 minutes before measuring blood pressure.
- Avoid smoking, drinking alcohol, or exercising within 30 minutes of measuring blood pressure.
When measuring blood pressure:
- Take readings at the same time each day.
- Sit with the back straight, legs uncrossed, and feet flat on the floor.
- Rest the arm on a flat surface so that the upper arm is at heart level.
- Place the cuff on the arm so that the bottom of the cuff is directly above the elbow crease.
- Take two or three readings approximately 1 minute apart and calculate the average value.
- Keep a record of all readings, as this can help a doctor determine the best course of treatment.
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